Abordaje de la complejidad psicosocial en pacientes con cáncer / Approaching psychosocial complexity in patients with cancer

ANTECEDENTES Y OBJETIVO: Evaluar el malestar emocional y el nivel de complejidad de pacientes presentados al Comité de Atención Psicosocial. MATERIALES Y MÉTODOS: Estudio pre-post con un solo grupo en pacientes con cáncer. De los 144 pacientes, 27 fueron derivados por el comité a especialistas del área psicosocial, y sus niveles de malestar emocional y de complejidad fueron revisados un mes después. RESULTADOS: Tras ser atendidos según indicaciones del comité, los pacientes mostraron un descenso significativo de los valores en malestar emocional: la media inicial de 8 puntos en la escala visual analógica de malestar emocional descendía a 5,8 puntos. El descenso se reflejó también en los niveles de complejidad: antes de ser revisados, el 70,4% de los pacientes mostraban un alto nivel de complejidad y el 7,4%, un nivel bajo. Después de ser atendidos, los porcentajes de pacientes con alta complejidad se redujeron al 48,1% en los enfermos con alta complejidad, y aumentaron al 22,3% en los de baja complejidad. CONCLUSIONES: El comité ofrece un instrumento para derivar los casos de mayor complejidad que requieren atención preferente y multidisciplinar, permitiendo optimizar recursos, por su eficacia en la resolución de casos complejos

BACKGROUND AND AIM: To assess emotional distress and complexity of patients referred to the Psychosocial Committee. MATERIAL AND METHODS: A pre-post single group study was performed in a sample of oncological patients. From the 144 patients referred to the committee, 27 were attended by psychosocial specialists. The patients' levels of emotional distress and psychosocial complexity were reviewed one month later. RESULTS: After having been attended according to the committee's indications, the patients showed significant decreases in emotional distress. The initial mean of 8 points on the emotional distress scale decreased to 5.81 points after having been referred to the specialist. This decline was also observed in psychosocial complexity. Before attendance, 70.4% patients showed high levels of complexity, and 7.4% showed low levels. After attendance, the percentages of patients with high levels of psychosocial complexity reduced to 48.1% and patients with low complexity increased to 22.2%. CONCLUSIONS: The committee provides an instrument to refer patients who show high levels of psychosocial complexity and require preferential and multidisciplinary attention. The committee optimizes resources due to its efficiency in resolving complex cases

Approaching psychosocial complexity in patients with cancer. / Abordaje de la complejidad psicosocial en pacientes con cáncer.

BACKGROUND AND AIM: To assess emotional distress and complexity of patients referred to the Psychosocial Committee. MATERIAL AND METHODS: A pre-post single group study was performed in a sample of oncological patients. From the 144 patients referred to the committee, 27 were attended by psychosocial specialists. The patients' levels of emotional distress and psychosocial complexity were reviewed one month later. RESULTS: After having been attended according to the committee's indications, the patients showed significant decreases in emotional distress. The initial mean of 8 points on the emotional distress scale decreased to 5.81 points after having been referred to the specialist. This decline was also observed in psychosocial complexity. Before attendance, 70.4% patients showed high levels of complexity, and 7.4% showed low levels. After attendance, the percentages of patients with high levels of psychosocial complexity reduced to 48.1% and patients with low complexity increased to 22.2%. CONCLUSIONS: The committee provides an instrument to refer patients who show high levels of psychosocial complexity and require preferential and multidisciplinary attention. The committee optimizes resources due to its efficiency in resolving complex cases.

Proceso de Bolonia (VI): aprendiendo comunicación para la salud en el Grado de Medicina / Bologna Process (VI): learning health communication in medical undergraduate

La comunicación forma parte de la actividad clínica y en ocasiones determina el éxito o fracaso del proceso asistencial. Sin embargo, no ha sido reconocida en los planes de estudio del Estado español hasta muy recientemente, sobre todo con el impulso del llamado 'Plan Bolonia'. En el año 2009 se aprobó en la Facultad de Medicina de la Universitat de Barcelona un nuevo plan docente que proponía incorporar la enseñanza de la comunicación en las materias clínicas y preclínicas, contabilizando entre 3 y 6 créditos europeos (ECTS), como competencia transversal. El presente artículo aborda el diseño de esta competencia, los pros y contras, cómo se inserta en diferentes asignaturas y cómo puede evaluarse (AU)

Communication is part of the clinical activity and sometimes determines the healthcare success or failure. However it has not been recognized in the Spanish curricula until recently, in the context of the so called Plan Bologna. In 2009 a new teaching plan was approved at Medical School of Barcelona University which intended to incorporate communication in clinical and preclinical areas (3-6 ECTS). In this article we explain pros and cons to introduce communication not as a subject, but as a competency, how can be integrated in different subjects and how can be evaluated (AU)

Evaluación de dos estrategias de cribado de cáncer colorrectal: test inmunológico versus test bioquímico. Cataluña, 2008-2010 / Evaluating colorectal cancer screening strategies (Immunological Test vs Biochemical Test) in Catalonia, Spain 2008-2010

Fundamento: El objetivo del estudio fue evaluar el cambio de estrategia de cribado (test inmunológico cuantitativo) en un programa poblacional de detección precoz de cáncer colorrectal (CCR) en Cataluña. Métodos: La cuarta ronda del programa de cribado de CCR en Hospitalet de Llobregat se implementó en 2008-2010. Se ofreció un test bioquímico a 50.227 individuos y uno inmunológico cuantitativo a 12.707 individuos. Se analizaron diferencias en las dos estrategias de cribado respecto a variables de aceptabilidad (entre participación, abandonos y adherencia a la colonoscopia), de precisión diagnóstica (valor predictivo positivo y tasas de detección), de resultados (tamaño y localización de lesiones, estadio de los cánceres detectados) y de recursos (número necesario de colonoscopias e intervalo de tiempo entre el resultado positivo del test y la colonoscopia). Resultados: La participación en el cribado fue superior entre los individuos que utilizaron el test inmunológico (OR: 1,35; IC95%:1,27- 1,42). Las tasas de detección fueron superiores para el test inmunológico destacando la de adenomas de alto riesgo (26,7‰vs 3,0‰). El valor predictivo positivo para adenomas de alto riesgo fue del 45,0% y del 46,9% en el inmunológico y el guayaco, respectivamente. El número de colonoscopias necesarias para detectar un cáncer fue de casi el doble que en el guayaco (13,6 vs 7,4). Conclusiones: El test inmunológico es una buena estrategia de cribado especialmente sensible para la detección de adenomas de alto riesgo. Sin embargo, requiere realizar un gran número de colonoscopias y por ello se debe disponer de los recursos y medios necesarios (AU)

Background: The aim of this study was to evaluate the screening strategy (quantitative immunological test vs biochemical test) in a population- based screening program for colorectal cancer (CRC) in Catalonia. Methods: The fourth round of a screening program for CRC with a fecal occult blood test was implemented in Hospitalet de Llobregat during 2008-2010.Abiochemical test was offered to 50,227 individuals and a quantitative immunological test was offered to 12,707 individuals. We analysed differences according to the screening strategy in the following variables: acceptability of the target population (participation, dropouts, and adherence to colonoscopy), diagnostic accuracy (positive predictive value and detection rates), results (size and location of lesions, staging of CRC) and resources (number of colonoscopies needed and time interval between the positive test and colonoscopy). Results: Participation was higher among individuals who used the immunological test (OR: 1.35; CI95%:1.27-1.42). Detection rates for adenomas and cancer were also higher for the immunological test, hightlighting the detection rate for high-risk adenomas (26.7‰ vs. 3.0‰). The positive predictive value for high-risk adenomas was 45.0% and 46.9% in the immunological test and guaiac test, respectively. The number of colonoscopies needed to detect cancer with the immunological test was almost two-fold than those needed with the guaiac test (13.6 vs 7.4). Conclusions: The immunological test is a good screening strategy particularly sensitive for detecting high-risk adenomas. However, it is paramount to have enough resources to assure the quality of the CRC screening due to the large number of colonoscopies that would be required (AU)

[Evaluating colorectal cancer screening strategies (immunological test vs biochemical test) in Catalonia, Spain 2008-2010]. / Evaluación de dos estrategias de cribado de cáncer colorrectal: test inmunológico versus test bioquímico. Cataluña, 2008-2010.

BACKGROUND: The aim of this study was to evaluate the screening strategy (quantitative immunological test vs biochemical test) in a population-based screening program for colorectal cancer (CRC) in Catalonia. METHODS: The fourth round of a screening program for CRC with a fecal occult blood test was implemented in Hospitalet de Llobregat during 2008-2010. A biochemical test was offered to 50,227 individuals and a quantitative immunological test was offered to 12,707 individuals. We analysed differences according to the screening strategy in the following variables: acceptability of the target population (participation, dropouts, and adherence to colonoscopy), diagnostic accuracy (positive predictive value and detection rates), results (size and location of lesions, staging of CRC) and resources (number of colonoscopies needed and time interval between the positive test and colonoscopy). RESULTS: Participation was higher among individuals who used the immunological test (OR: 1.35; CI95%:1.27-1.42). Detection rates for adenomas and cancer were also higher for the immunological test, hightlighting the detection rate for high-risk adenomas (26.7‰ vs. 3.0‰). The positive predictive value for high-risk adenomas was 45.0% and 46.9% in the immunological test and guaiac test, respectively. The number of colonoscopies needed to detect cancer with the immunological test was almost two-fold than those needed with the guaiac test (13.6 vs 7.4). CONCLUSIONS: The immunological test is a good screening strategy particularly sensitive for detecting high-risk adenomas. However, it is paramount to have enough resources to assure the quality of the CRC screening due to the large number of colonoscopies that would be required.